Somerville College
Ref: E220Equal Opportunities Monitoring Form (Recruitment)CONFIDENTIAL
Higher education institutions have a legal duty to collect, analyse and publish equal opportunity data about characteristics that are protected against discrimination under the Equality Act 2012, such as age, race, and disability. Somerville is keen to comply with this legal duty so that it is able to measure the effectiveness of its equality policies, and to ensure that those who work and study at Somerville are treated equally and discrimination involving the ‘protected characteristics’ is avoided.
Therefore we need you to provide the College with your personal equal opportunities data by completing and returning this form to the Human Resources team. Any information you provide will be presented in an anonymous format and any data that has the potential to identify you as an individual will not be published. The information collected through this form will be held on the Human Resources database and will be accessible only by the Human Resources staff. Data you supply will be kept strictly confidential and according to the Data Protection Act 1998. Please answer the questions below by completing or ticking the appropriate box.
Age / Prefer not to saySex/Gender / Male / Female / Prefer not to say
Disability
Disability is defined as a physical or mental impairment, and the impairment has a substantial (i.e. more than minor or trivial) and long-term adverse effect on your ability to carry out normal day-to-day activities
Do you have a disability or a long term medical condition that has lasted for at least 12 months, or is likely to last for at least 12 months, or is likely to last for the rest of your life? / Yes / No / Prefer not to say
What is your disability?
No known disability / Deaf or serious hearing impairment
Blind or serious impairment uncorrected by glasses / Long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
Two or more impairments and/or disabling medical conditions / Mental health condition, such as depression, schizophrenia or anxiety disorder
General Learning disability (such as Down’s syndrome / Physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or crutches
Social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder / A specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
A disability, impairment or medical condition not listed above / Prefer not to say
Ethnicity
Questions about ethnicity are not about nationality, place of birth, or citizenship, they are about colour and ethnic group.
What is your ethnicity?
White / Other Asian background
Gypsy or Traveller / Mixed - White and Black Caribbean
Black or Black British - Caribbean / Mixed - White and Black African
Black or Black British - African / Mixed - White and Asian
Other Black background / Any other mixed background
Asian or Asian British - Indian / Arab
Asian or Asian British - Pakistani / Other ethnic background
Asian or Asian British - Bangladeshi / Not known
Chinese / Prefer not to say
Sexual Orientation
What is your religion?
Bisexual / Gay woman / Lesbian
Heterosexual / Other
Gay man / Prefer not to say
Religion or Belief (including lack of belief)
What is your religion?
Atheism / Judaism
Buddhism / Sikhism
Christianity / Spiritualism
Hinduism / Any other religion or belief
Islam / No religion
Jainism / Prefer not to say
Marriage and Civil Partnership
Are you married or in a civil partnership? / Yes / No / Prefer not to say
Nationality
What is your nationality? / Prefer not to say
Please return one copy of this form to the Human Resources Manager
By hard copy to: Somerville College, Woodstock Road, Oxford. OX2 6HD
Or by email to:
Thank you.
Code: (Note –code used at the top of this form is a unique number and identifies the person who has completed this form only to the Human Resources Manager and Human Resources Administrator).